Preterm premature rupture of membranes between 14 and 24 weeks of gestation: outcomes with expectant management.

INTRODUCTION: The objective of this study was to examine maternal and neonatal outcomes for patients with previable and periviable preterm premature rupture of membranes (PPROM) who were expectantly managed.

METHODS: Retrospective cohort study of women with PPROM admitted to the hospital between January 1, 2007, and December 31, 2011. Pre- and periviable PPROM was defined as rupture of the amniotic sac between 14 and 23+6 weeks of gestation.

RESULTS: Forty-three patients were included in the study with 36 (83.7%) having a documented cervical examination at rupture of membranes. Gestational age at rupture of membranes ranged from 14.4 to 23.9 weeks (median 21.9) and gestational age at delivery ranged from 15.0 to 39.1 weeks (median 23.6 weeks of gestation). Latency period ranged from 1 day to 24.7 weeks (median 1.0 week). There was not a significant difference between dilated and not dilated patients in gestational age at rupture of membranes (median 21.3 compared with 22.1 weeks of gestation, respectively; P=.661); however, there was a significant difference in latency (median 4 days compared with 3.6 weeks, respectively; P=.001) and gestational age at delivery (23.1 compared with 24.9 weeks of gestation, respectively; P=.015). Of the 44 fetuses, 16 (36.4%) survived to discharge. Neonates born to mothers who ruptured at less than 21 weeks of gestation (n=17) were 20 times more likely to die than neonates born to mothers who ruptured greater than 21 weeks of gestation (odds ratio 0.050, 95% confidence interval 0.006-0.443). With the exception of one outlier, no neonate survived when PPROM occurred at less than 21 weeks of gestation.

CONCLUSION: Survival with rupture of membranes at less than 21 weeks of gestation was rare. Given this poor prognosis, it is reasonable to counsel patients on induction of labor.